This past week I was informed that a patient whom I had treated died. This patient was suffering from a multitude of cancer-related problems that, when coupled with an infection, were too much to overcome. The patient's infectious problems weren't the stuff of movies nor was he infected with something with an ominous name. However, his death is a lesson in what the practice of infectious disease entails today and will increasingly entail in the future.

My patient died with an enterococcal bloodstream infection. Because of characteristics it possessed, this puny bacterium proved too difficult to treat. While enterococcus is not a bacterium that most people know about, some may have heard of its more troublesome form: VRE.

VRE is the acronym for vancomycin-resistant enterococci, a form of the bacterium not killed by the workhorse antibiotic vancomycin. When infections with VRE occur we usually have several other options to try. This VRE with which I was battling wasn't just any VRE though, it was resistant to the next drug we tried as well, daptomycin. And, because this was a serious bloodstream infection that had secondarily infected his heart valves, drugs like linezolid--which only inhibit enterococcal growth and don't kill it--would be expected to fail as well given the nature of the infection (it did). Novel combinations of antibiotics (ceftaroline + daptomycin) were also attempted and failed.

In the end, I turned back to an old but painful friend, Synercid. This antibiotic which was the first targeted to VRE enjoyed a brief 15 minutes of fame until it was supplanted by linezolid and daptomycin. This fame ended when it was realized that hours of pain, in the form of joint aches, were the result of Synercid administration. I warned the patient and he bravely bared the aches and pains. Initially, I had hope as he initially cleared his blood of the bacteria but later surveillance cultures revealed that it had not actually been vanquished. No surgical options were available as cancer had diminished the patient's immune system as well as the ability of his blood to clot.

This enterococcus was one bad bug for which there was no drug and it cost a man his life.